Well, it could mean a number of things. Just like many other laboratory blood tests that you or your doctor may have initiated, an unusually high PSA result should be interpreted as a signal to further investigate. You should engage with a urologist to discuss whether there might be a reason to question the test result’s accuracy or whether you should further look into the cause of the high reading. I’m not going to assume that your doctor is aware of your result yet, because my first PSA several tests were administered through a “wellness” test at my place of work, and not through my internist…my internist’s standard protocol is to begin regular PSA testing at age 50 unless there are other indications or family history. If you’ve seen an internist, he can recommend a urologist in your area.

First of all, there are numerous reasons that a PSA result might be high that have nothing to do with prostate cancer, like riding a bicycle or motorcycle, or similar activity, within a week of the test because these tend to “massage” the prostate area (and can artificially elevate PSA). Similarly, ejaculation raises PSA results, and so any sexual activity within 48 hours or so of the test can temporarily elevate PSA (thereby giving an inaccurate result). Re-testing will probably be recommended if you can definitively point to some activity like this just before the test was administered.

Secondly, there are several “illnesses” that your prostate may have, each having nothing to do with prostate cancer, which would elevate your PSA. It could be an inflamed prostate (“prostatitis”), in which the solution may be a course of antibiotics (followed by re-testing). It could also be a non-malignant enlargement of the prostate known as “benign prostate hyperplasia”, or BPH. In either of these cases, your urologist might order some additional blood work to help identify the root cause, and also perform a DRE, digital rectal exam (finger up your butt) to feel the texture of the backside of the prostate (thru your rectum wall).

Lastly, only after eliminating the things listed above and probably after several PSA tests and/or other blood testing, your urologist may recommend a biopsy to look for cancerous cells. For reasons like those I gave (biking, sexual activity), the PSA test might result in an inaccurate “false positive”; but on the other hand the biopsy is a definitive test for cancer. A “false positive” almost never occurs, although a “false negative” may occur—this happens if the sampled areas for the biopsy completely miss any of the cancerous cells in your prostate, perhaps because the cancerous area is still very small. A thorough urologist performing a biopsy will take 12, or even 20, samples from various locations 3-dimensionally in the walnut-sized prostate to try to minimize this possibility. I believe the important thing to keep in mind is that if there is cancer in your prostate, it is to your great advantage to find it early. Early detection means i) more treatment options, ii) better chance of cure, and iii) better quality of life after treatment.

So, a high PSA result can mean lots of things…but most importantly I would urge that it should be a signal to further investigate. Keep us informed. Lots of guys on this board can help guide you down your path.

Well, it could mean a number of things. Just like many other laboratory blood tests that you or your doctor may have initiated, an unusually high PSA result should be interpreted as a signal to further investigate. You should engage with a urologist to discuss whether there might be a reason to question the test result’s accuracy or whether you should further look into the cause of the high reading. I’m not going to assume that your doctor is aware of your result yet, because my first PSA several tests were administered through a “wellness” test at my place of work, and not through my internist…my internist’s standard protocol is to begin regular PSA testing at age 50 unless there are other indications or family history. If you’ve seen an internist, he can recommend a urologist in your area.

First of all, there are numerous reasons that a PSA result might be high that have nothing to do with prostate cancer, like riding a bicycle or motorcycle, or similar activity, within a week of the test because these tend to “massage” the prostate area (and can artificially elevate PSA). Similarly, ejaculation raises PSA results, and so any sexual activity within 48 hours or so of the test can temporarily elevate PSA (thereby giving an inaccurate result). Re-testing will probably be recommended if you can definitively point to some activity like this just before the test was administered.

Secondly, there are several “illnesses” that your prostate may have, each having nothing to do with prostate cancer, which would elevate your PSA. It could be an inflamed prostate (“prostatitis”), in which the solution may be a course of antibiotics (followed by re-testing). It could also be a non-malignant enlargement of the prostate known as “benign prostate hyperplasia”, or BPH. In either of these cases, your urologist might order some additional blood work to help identify the root cause, and also perform a DRE, digital rectal exam (finger up your butt) to feel the texture of the backside of the prostate (thru your rectum wall).

Lastly, only after eliminating the things listed above and probably after several PSA tests and/or other blood testing, your urologist may recommend a biopsy to look for cancerous cells. For reasons like those I gave (biking, sexual activity), the PSA test might result in an inaccurate “false positive”; but on the other hand the biopsy is a definitive test for cancer. A “false positive” almost never occurs, although a “false negative” may occur—this happens if the sampled areas for the biopsy completely miss any of the cancerous cells in your prostate, perhaps because the cancerous area is still very small. A thorough urologist performing a biopsy will take 12, or even 20, samples from various locations 3-dimensionally in the walnut-sized prostate to try to minimize this possibility. I believe the important thing to keep in mind is that if there is cancer in your prostate, it is to your great advantage to find it early. Early detection means i) more treatment options, ii) better chance of cure, and iii) better quality of life after treatment.

So, a high PSA result can mean lots of things…but most importantly I would urge that it should be a signal to further investigate. Keep us informed. Lots of guys on this board can help guide you down your path.

Welcome to this board. All of us wish we did not have to be involved with prostate cancer, but at least we have some excellent company on this board!

Kcon gave a good description of PSA testing and some reasons why a PSA might not mean cancer. Probably all of those reasons have some meaning for the score of 600 that you are concerned about. One of the reasons I learned about such other causes for a high PSA was that my own first-ever PSA was 113.6, and I was dearly hoping there would be an explanation for such a score other than an aggressive case of prostate cancer.

However, it would be wise to prepare for dealing with a case of aggressive prostate cancer. Unless there has been a huge and extremely unusual error in processing the test in the lab, that PSA of 600 is probably beyond the range of other possible suspects, as I understand it. I'm a layman with no enrolled medical education, but I've had to learn a lot about this disease in order to cope with my own challenging case, including the likelihood of other explanations for high PSAs. Here are some thoughts and facts.

Infection of the prostatitis can account for some high PSAs, with a score of 50 quite possible. I have even heard of a man whose PSA kept rising til it hit around 200 before dropping all the way back to normal when the source of the infection was identified and the right medication finally given. But 600 is well beyond even that extremely rare level of 200.

Unfortunately, the same kind of thinking goes for other usual causes that kcon also mentioned: those other causes, which are quite important when the PSA is in the 1 to 10 range, usually account for a small increase in PSA compared to a score of 600. There's still a chance and always room for prayers, but it is wise to be prepared.

Kcon described the biopsy as a step to identify what is going on, and, with a score of around 600, there is no reason I know of not to get right to it. Normally, bone scans and CT scans that are also frequently done for new patients are almost useless for low risk cases, but they make a lot of sense for cases starting out with such a high PSA. The biopsy would come first, but then the other scans could follow quickly. If the biopsy finds that there is cancer, then the scans can go a long way toward telling if it has spread to the bones and lymph nodes, both likely targets for aggressive prostate cancer.

Knowing the PSA doubling time (PSADT) - how long it takes the PSA to double - is a helpful clue, and it would not hurt to get another PSA before the biopsy, provided at least a week has passed since the last one. Even two fairly close PSAs would give a rough estimate of PSADT. It doesn't make sense after the biopsy for weeks because the biopsy will affect the PSA score for a while.

If the biopsy results are consistent with the PSA, then the patient should probably seek out top level talent, ideally, a doctor who specializes in prostate cancer. Surgery would almost surely not be a worthwhile option in view of the likelihood of spread. Radiation might be an option, but only if the cancer that can be detected by scans is all within the range of the radiation system to be used. Hormonal blockade therapy would probably be a good choice, and some physicians are exploring giving other heavy duty drugs at the start along with hormonal blockade therapy for challenging cases.

The drug Provenge, which just passed its clinical trial, might be appropriate. It has not yet been approved by the FDA, but it is highly likely to be approved by this time next year, and we will get detailed results when the fine points of the trial results are revealed tomorrow to the world at 2 PM (at the annual meeting of the American Urological Association in Chicago).

If the doctor or doctors are pessimistic after the biopsy, that's probably mainly because they are not used to dealing with what could be a challenging case. However, true specialists have typically seen a fair number of patients with PSAs of 600 or higher and know some good techniques for dealing with such cancers.

But this is getting ahead of where you are today.

It would help to know more about the patient and the case.

I'll close by saying that hope and optimism appear to be vitally important to prostate cancer patients with challenging cases. Also, research is advancing at a rapid rate for prostate cancer, giving us a good basis for our hope.

Take care and keep your spirits up.

Jim

Last edited by IADT3since2000; 04-27-2009 at 07:57 PM.
Reason: Corrected American Urological Society to American Urological Association.